The Impact of Comorbidity of Depression and Anxiety on Outcomes of Illness

The impact depression and anxiety can have on outcomes of medical procedures and illness is significant. Older adults do not always present in the same way as a younger population regarding symptoms related to these illnesses. It is not uncommon for health care professionals to miss or ignore a diagnosis of depression or anxiety because they feel the symptoms are fully explained by the situation. A missed diagnosis can have detrimental effects on outcomes, transition back home, and return to functioning.

In this teaching strategy the student will meet Eugene Shaw, an 82 year old former marine who served in the Korean War. This teaching strategy focuses on Eugene’s hospitalization for vascular problems related to his diabetes and subtle hints that he may have an underlying depression or anxiety. The activities are directed at evaluating and better understanding the complexities of these diagnoses compounded with his medical problems. In addition, the student will explore the general impact of stress, depression, and anxiety on outcomes when seen in concert with chronic illness.

1. Consider what assessment tools would be appropriate for continuing to evaluate Eugene. Utilize these tools to better understand:

The behaviors associated with Major Depression

Evidence of any cognitive impairment that may be complicating Eugene’s recovery

The overlap of depressive, cognitive and anxiety behaviors and what they mean

How alcohol may be a factor in compromising outcomes

What is Eugene’s baseline level of functioning and whether he has deviated from that point

How to evaluate Mrs. Shaw’s ability to manage the caregiving role

2. A concept map is a diagram that illustrates relationships among concepts. Assign a concept map to students after they listen to the monologue or have the students do a concept map as a group project in class/seminar, or as a pos-t­conference activity. In the third scenario of the simulation, Eugene is recovering from surgery. Introduce this snapshot of his life to the students as they develop the concept map. This activity allows students to see the repercussions of depression especially in the older adult recovering from surgery. See the example of a draft of a concept map in the materials section.

In completing this exercise students should consider:

What is depression?

What are the causes for depression?

What are the symptoms of depression?

What are the pharmacological treatments for depression?

Will these treatments impact any other treatments the patient may be getting?

ConsultGeri.org; the website of the Hartford Institute for Geriatric Nursing at New York University's College of Nursing contains many evidence-based assessment tools. Those listed below from the Try This® and How to Try This Series® focus on tools that would help in assessing a client like Eugene.

Download the draft of a sample concept map illustrating the concept of depression. Please note that this is only a sample and not inclusive of all of the connections between depression and functioning. It should be used only as a draft and not considered a complete concept map related to the Eugene Shaw case.